Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Quality/Cost, International Comparisons -- OUCH!

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The following lists are from  Note that the US ranks at the bottom of 19 industrialized countries in preventable deaths/100,000 population. Top 25 countries with the best healthcare systems The Top 10 Medical Travel Destinations How the Performance of the U.S. Health Care System Compares Internationally (Health Expenditures/Capita) Health Expenditures per Capita - Seven Selected Countries

Really Poor Performance, U.S.A.!

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Beyond our obvious quality problems.... Yearly, approximately 100,000 patients die of health care–associated infections, about another 100,000 die from other preventable errors, and "tens of thousands more die of diagnostic errors or failure to receive recommended therapies."1-3 But, That’s Just the Obvious Quality Problems.  Possibly Related Is That Our Mortality Rates Pale In Comparison to Other Industrialized Countries


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The cost of health care is already dear and rising exponentially while its "value" or the return on investment diminishes. What can be done?

When Practitioners Collaborate, It Can Clinically Help, Financially Hurt or Both

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Is it the patient's fault when they end up getting needed care out-of-network, i.e., from physicians who aren't part of the managed care network, the referral list is too thin or restrictive, the right specialist is elsewhere (or so it seems), or simply because there was no opportunity to choose an in-network doctor? Referrals Tell Us a Great Deal About Collaboration Among Practitioners

Reducing Economic Pain

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The "areas in which the proper reform measures could generate savings that could pay for universal coverage" include, but are not limited to unecessary and presumably unhelpful care, fraud and from the perspective of the physician, extraneous administrative expenses. Unnecessary care is believed to be responsible for as much as 30% of health care spending,2 or up to $830 billion this year alone.

Billing Beyond Customary

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Your health plan or doctor's office seems to see your heart attack, broken leg or laceration differently than you do.  They may want you to pay for that which one would ordinarily believe is covered.  In general, that is what consumer advocate, Ralph Nader calls "The Crime of Overbilling Healthcare." [Pub online August 31, 2014]

"Health Care" and "Insurance Companies"--Oxymoron

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"I don't understand why health care and insurance companies keep appearing in the same sentences." (Fisher, W. Truthout 10/25/09) Isn't it frustrating to have to live under employment based health care insurance?  If you lose your job, your employer wants to cut back, or you are a peasant, you're screwed!  Also, as a result of the way we are paid and the insurance model itself, there are many forces today that steal us away from the exam table or bedside.

Autism and Autistic Behavior

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Autism Spectrum Disorders (ASDs) From the American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR), which provides standardized criteria to help diagnose ASD. Diagnostic Criteria for 299.00 Autistic Disorder A. Six or more items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): 1. qualitative impairment in social interaction, as manifested by at least two of the following: